Individual
SHANE EDWARD WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
9909 WAMPLERS LAKE RD, BROOKLYN, MI 49230-9503
(517) 592-8208
Mailing address
9909 WAMPLERS LAKE RD, BROOKLYN, MI 49230-9503
(517) 592-8208
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301011096
MI
Other
Enumeration date
05/10/2021
Last updated
05/10/2021
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